I have a post up on healthinsurance.org about current and possible future state initiatives to sweeten the benefit pot (though it doesn't address the subsidy bump-ups provided by Massachusetts and Vermont). Here's the first section:
Remember the public option? It was a linchpin of early Democratic health reform blueprints for what became the Affordable Care Act. The health insurance marketplace would be anchored by a government-run health plan that would work to keep costs low and make coverage as comprehensive as possible. Private insurers in the marketplace would have to compete against it.Hope you'll read the whole thing.
The insurance industry lobbied hard against the public option, and the most conservative Democratic senators killed it. (Every Democratic vote was needed to pass the law, because Republicans rejected it en masse.)
When the ACA passed without a public option in 2010, some observers speculated that Congress might come back to establish one at a later point, if competition among private insurers proved a force too weak to keep coverage affordable. But that is clearly not going to happen on a national level with Republicans in control of Congress.
There is one way a public option could become a reality in fairly short order, however. The ACA didn’t create one market for health insurance, but rather 51 markets – one for each state plus the District of Columbia. And states have considerable freedom to shape their insurance markets, should they wish to seize it. “Nothing in the ACA stands in the way of a state creating a public option,” notes Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.
While no state has yet moved to create a public option, two states, Minnesota and New York, have taken what might be understood as a halfway step – or else an alternate route to more affordable care. That is, they have deployed a state-run Basic Health Plan (BHP) that provides comprehensive coverage at very low premiums to state residents with household incomes below 200 percent of the Federal Poverty Level (FPL).
To date, about two-thirds of enrollees in private plans offered in the ACA marketplace are in households with incomes below that threshold. The as-yet unanswered challenge for states committed to making the ACA work for all their citizens is to make coverage more affordable for people with somewhat higher incomes. As we will see, though, Minnesota may be poised to take a large step in that direction.